Bicarbonate Levels Research Articles

Pre-treatment bicarbonate levels and decongestion by acetazolamide: the ADVOR trial.

Acetazolamide inhibits proximal tubular sodium and bicarbonate re-absorption and improved decongestive response in acute heart failure in the ADVOR trial. It is unknown whether bicarbonate levels alter the decongestive response to acetazolamide. This is a sub-analysis of the randomized, double-blind, placebo-controlled ADVOR trial that randomized 519 patients with acute heart failure and volume overload in a 1:1 ratio to intravenous acetazolamide (500 mg/day) or matching placebo on top of standardized intravenous loop diuretics (dose equivalent of twice oral maintenance dose). The primary endpoint was complete decongestion after 3 days of treatment (morning of day 4). Impact of baseline HCO3 levels on the treatment effect of acetazolamide was assessed. : Of the 519 enrolled patients, 516 (99.4%) had a baseline HCO3 measurement. Continuous HCO3 modelling illustrated a higher proportional treatment effect for acetazolamide if baseline HCO3 ≥ 27 mmol/l. A total of 234 (45%) had a baseline HCO3 ≥ 27 mmol/l. Randomization towards acetazolamide improved decongestive response over the entire range of baseline HCO3- levels (P = 0.004); however, patients with elevated baseline HCO3 exhibited a significant higher response to acetazolamide [primary endpoint: no vs. elevated HCO3; OR 1.37 (0.79-2.37) vs. OR 2.39 (1.35-4.22), P-interaction = 0.065), with higher proportional diuretic and natriuretic response (both P-interaction < 0.001), greater reduction in congestion score on consecutive days (treatment × time by HCO3-interaction <0.001) and length of stay (P-interaction = 0.019). The larger proportional treatment effect was mainly explained by the development of diminished decongestive response in the placebo arm (loop diuretics only), both with regard to reaching the primary endpoint of decongestion as well as reduction in congestion score. Development of elevated HCO3 further worsened decongestive response in the placebo arm (P-interaction = 0.041). A loop diuretic only strategy was associated with an increase in the HCO3 during the treatment phase which was prevented by acetazolamide (day 3: placebo 74.8% vs. acetazolamide 41.3%, P < 0.001). Acetazolamide improves decongestive response over the entire range of HCO3- levels; however, the treatment response is magnified in patients with baseline or loop diuretic-induced elevated HCO3 (marker of proximal nephron NaHCO3 retention) by specifically counteracting this component of diuretic resistance.

Loss of Kir5.1 disturbs acid-base homeostasis in Dahl salt-sensitive rats

Renal basolateral inwardly-rectifying potassium (K ir ) channels contribute to the maintenance of the resting membrane potential and potassium homeostasis. Heteromeric K ir 4.1/K ir 5.1 channels are more sensitive to intracellular acidification than homomeric K ir 4.1 channels. Our previous study demonstrated that genetic mutation of Kcnj16 (the gene encodes K ir 5.1) causes chronic metabolic acidosis with lower blood pH and bicarbonate levels in Dalh salt-sensitive (SS) rats. Here, we aim to investigate the underlying mechanisms. We hypothesized that loss of K ir 5.1 disturbs acid-base homeostasis in SS rats by impairing ammoniagenesis in the proximal tubule and HCO3 - reabsorption in the distal convoluted tubule (DCT).12-week-old male SS WT and SS Kcnj16-/- rats were separated into two groups (N=5 per group). At the end of the experiment, kidneys were flushed and processed for blood pH and Western blot analysis.Western blot analysis indicated that knock out of K ir 5.1 causes lower expression of sodium-coupled neutral amino acid transporter 3 (SNAT3), which may indicate defective ammoniagenesis in the proximal tubule. On the other hand, increased expression of NBCe1 and NHE3 suggests enhanced HCO3 - reabsorption and H + excretion. Additionally, the expression of vacuolar ATPase (V-ATPase), which is a proton pump responsible for controlling the intracellular and extracellular pH of cells, remained the same. In the following experiments, we will further investigate the ammoniagensis in the proximal tubule as well as key bicarbonate transporters in DCT and collecting duct. Funding sources: National Institute of Health Grants R35 HL135749 (to AS), Department of Veterans Affairs grant I01 BX004024 (to AS). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract #1411932: Pseudo-myocardial Infarction in Diabetic Ketoacidosis with Normokalemia

Diabetic ketoacidosis (DKA) is a rare cause of the “pseudo-infarct pattern." It indicates the presence of EKG changes suggestive of myocardial ischemia without a coronary artery lesion. Pseudo-myocardial infarction has been associated with hyperkalemia seen in DKA. We report a case of ST elevation in the absence of a coronary artery lesion in a patient presenting with severe DKA and normokalemia. 41-year-old male with a history of type-1 diabetes mellitus with HbA1c of 13.6%, presented with altered mental status and unresponsiveness. He was intubated in the emergency department. Labs revealed severe DKA with glucose of 1307 mg/dl, non-calculable anion gap metabolic acidosis with bicarbonate level of <10 mEq/L, and B- hydroxybutyrate of 12.38mmol/L. Serum potassium level was normal at 5.1 mEq/L. Other electrolyte derangements include phosphorous at 11.9 mg/dl, magnesium at 4.6 mg/dl, and sodium at 146 mEq/L. Initial EKG revealed bradycardia without ischemic changes. He was started on DKA protocol with insulin drip, resulting in the closure of the anion gap and improvement of blood sugars. The next day, EKG was notable for ST elevations suggestive of anteroseptal infarction. Troponin level was 16.7 ng/ml. Serum potassium remained normal at 3.5 mEq/L. Due to risk factors for coronary artery disease (CAD), he underwent a coronary angiogram and was found to have normal coronaries. EKG changes are thought to be in the setting of DKA, which was subsequently resolved. Several cases have reported ST segment changes in patients with DKA. However, these have been associated with hyperkalemia. The EKG changes in our case were seen in the normokalemia setting and after the anion gap closure. In the absence of metabolic derangements, the etiology of the pseudo-infarct pattern remains unclear. As diabetes is a risk factor for CAD, these patients require ischemic evaluation with a coronary angiogram.

Geochemical Survey and Estimation of Baseline Concentrations of Major and Trace Elements in Stream Water, Uttar Pradesh, India: Implication for Environmental Studies

Abstract Stream water plays an important role in the development of habitats. It is one of the important sources of water used for drinking and irrigation in the region. Before using, it is necessary to test the quality of all types of surface water available for various use. A geochemical study of stream water has been conducted in parts of Pratapgarh, Raebareli, and Allahabad districts of Uttar Pradesh to assess its suitability for domestic purposes and establish the baseline concentration of major ions, trace and REEs. 20 samples of stream water from different locations of 1st or 2nd order streams were collected during post-monsoon period, from 18th to 31st October 2021. Different hydrochemical parameters such as pH, electrical conductivity (EC), temperature, dissolved oxygen (DO), salinity, total dissolved solids (TDS), major cations and anions were analysed. In order to obtain maximum quality and purity of water, the stream water samples were analyzed by ICP-MS analytical method in the chemical lab for 47 trace elements including REEs contents. The obtained values of each parameter have been compared with the standard values recommended by BIS and WHO. The value of each element except uranium has been found to be within the desirable and permissible limits prescribed by BIS (2012) and WHO (2006). Selenium and arsenic have been found to be marginally exceed the permissible limits. The pH values of all stream waters in the study area range from 7.14 to 8.86 with an average value of 7.86 indicating an alkaline nature of stream water. The concentration of uranium in stream water varied from 1.5 ppb to 48.67 ppb with a mean value of 7.9 ppb. It is observed that wherever concentration of uranium in the samples increased, the pH as well as the bicarbonate level increased accordingly. Correlation coefficient revealed that uranium is strongly correlated with bicarbonate (r=0.67), moderately with sodium (r=6.1), and low positively correlated with the concentration of pH (r=0.34), EC (r=0.52), and salinity (r=0.52), indicates the same origin. Water quality index (WQI) of water was determined for suitability of drinking purpose, revealed that 65% water samples fall in excellent category and 30% water samples fall in good category while only 5% water sample are in poor category. Trilinear plot of sample shows that most of the stream water samples are Ca-Mg-HCO3 type.

Treatment costs for patients with Streptococcus suis infection in Northern Thailand: a hospital-based observational study of 14-year data

BackgroundStreptococcus suis (S.suis) is a neglected zoonotic disease that imposes a significant economic burden on healthcare and society. To our knowledge, studies estimating the cost of illness associated with S.suis treatment are limited, and no study focuses on treatment costs and potential key drivers in Thailand. This study aimed to estimate the direct medical costs associated with S.suis treatment in Thailand and identify key drivers affecting high treatment costs from the provider’s perspective.MethodsA retrospective analysis of the 14-year data from 2005–2018 of confirmed S.suis patients admitted at Chiang Mai University Hospital (CMUH) was conducted. Descriptive statistics were used to summarize the data of patients’ characteristics, healthcare utilization and costs. The multiple imputation with predictive mean matching strategy was employed to deal with missing Glasgow Coma Scale (GCS) data. Generalized linear models (GLMs) were used to forecast costs model and identify determinants of costs associated with S.suis treatment. The modified Park test was adopted to determine the appropriate family. All costs were inflated applying the consumer price index for medical care and presented to the year 2019.ResultsAmong 130 S.suis patients, the average total direct medical cost was 12,4675 Thai baht (THB) (US$ 4,016), of which the majority of expenses were from the “others” category (room charges, staff services and medical devices). Infective endocarditis (IE), GCS, length of stay, and bicarbonate level were significant predictors associated with high total treatment costs. Overall, marginal increases in IE and length of stay were significantly associated with increases in the total costs (standard error) by 132,443 THB (39,638 THB) and 5,490 THB (1,715 THB), respectively. In contrast, increases in GCS and bicarbonate levels were associated with decreases in the total costs (standard error) by 13,118 THB (5,026 THB) and 7,497 THB (3,430 THB), respectively.ConclusionsIE, GCS, length of stay, and bicarbonate level were significant cost drivers associated with direct medical costs. Patients’ clinical status during admission significantly impacts the outcomes and total treatment costs. Early diagnosis and timely treatment were paramount to alleviate long-term complications and high healthcare expenditures.

Prevalence of metabolic acidosis in ileal diversions more than one year after radical cystectomy and associated secondary metabolic effects

Introduction and objectiveMetabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. Materials and methodsWe conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level ​​<22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24 ± 42.36 months. ResultsMA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19,65%, p < 0.001) and renal failure (100% vs 45,29%, p < 0.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values ​​of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all p < 0.05).Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR 0.914; 95% CI 0.878−0.95; p < 0.0001), proving a close correlation with venous bicarbonate values ​​(r = 0.387, p < 0.001). ConclusionsMA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.

Correlation Between Serum and Arterial Blood Gas Bicarbonate in Patients Admitted to the Intensive Care Unit.

Objective Clinicians use two modalities to determine acid-base disturbances: calculated bicarbonate on arterial blood gas (ABG) and measured bicarbonate on basic metabolic panels (BMP).The primary objective was to investigate the discrepancy between the two values for diagnosing acidemia in the intensive care unit (ICU). Our secondary objective was to discern the threshold to treat acidemia within various clinical settings. Materials and methods We performed a multi-center study using a retrospective patient chart review consisting of ABG and BMP bicarbonate levels at various pH ranges; 584 adult patients were included in this study. SAS software (SAS Institute Inc., Cary, NC) was used for analysis. Results Strong positive correlations were found between calculated ABG and measured BMP bicarbonate, with the group of pH 6.9-7.0 being the strongest. Based on odds ratio analysis, patients were more likely to not receive bicarbonate treatment if pH was greater than 7.1 based on calculated ABG bicarbonate. Patients also did not receive bicarbonate treatment when pH was greater than 7.2 based on BMP bicarbonate levels. Our study found that patients with higher pH (pH > 7.1) were less likely to receive bicarbonate treatment. Patients with pH 6.9-7.0 were more likely to receive bicarbonate treatment. Based on receiver operator curve(ROC)model curves, neither ABG nor BMP bicarbonate values have strong accuracy for diagnosing acidemia. Conclusion We found no significant difference in CO2 levels and ICU types regardless of if ABG or BMP was used.

Jatropha tanjorensis Euphorbiaceae ameliorates aspirin-induced hepatotoxicity and maintain electrolytes balance in albino Wistar rats

BackgroundA great number of modern medicines derived from plants are considered as important sources of medicinal agents to treat different diseases. J. tanjorensis belongs to the family Euphorbiaceae, which is known for various medicinal uses. PurposeThe hepatoprotective effect of ethanolic extract of J. tanjorensis Euphorbiaceae and maintenance of electrolytes balance in aspirin-induced hepatotoxic condition in Wistar rats was studied. Methods20 Wistar rats of both sexes weighing between (180–200 g) were divided into 4 groups of 5 rats each. normal rat (group 1); J. tanjorensis Euphorbiaceae (200 mg/kg group 2); aspirin (250 mg/kg group 3); aspirin (250 mg/kg) + J. tanjorensis Euphorbiaceae (200 mg/kg group 4). Serum levels of the enzymes aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and electrolytes (Na+, K+, Cl−, and HCO3−) was assessed at the end of treatment which lasted twelve (12) weeks. ResultsWhen compared to control, J. tanjorensis Euphorbiaceae - treated, and aspirin+ J. tanjorensis Euphorbiaceae - treated groups, blood electrolyte results in aspirin-treated group indicated a significant decrease (p<0.05) in sodium, potassium, chloride, and bicarbonate levels, respectively. Treatment with J. tanjorensis Euphorbiaceae leaves extract resulted in normal levels of serum electrolytes (Na+, Cl−, and HCO3−). When compared to J. tanjorensis Euphorbiaceae, control, and aspirin + J. tanjorensis Euphorbiaceae -treated groups, the serum liver enzyme level was significantly (p<0.05) increased in the aspirin-treated group. When compared to the aspirin treated group, serum liver enzymes level in the J. tanjorensis Euphorbiaceae treated group was significantly lower (p<0.05). The relative liver weight and mean body weight in the aspirin-treated group was significantly lower (p<0.05) compared to J. tanjorensis Euphorbiaceae, control, and aspirin + J. tanjorensis Euphorbiaceae - treated groups respectively. ConclusionThe results suggest ethanolic leaves extract of J. tanjorensis Euphorbiaceae offered hepato-protective effect in aspirin-induced hepatotoxic condition on tissues, ameliorated both hyponatriemia and hyperkalemia effects, and maintained normal electrolytes concentration in animal models.

Effect of Carica papaya Leaves and Seeds on Electrolyte and Hematological Parameters in Albino Wistar Rats Exposed to Lead Nitrate

Background: Exposure to lead produces a variety of adverse health effects. This study evaluated the effect of aqueous extracts of Carica papaya leaves and seeds on electrolyte and hematological parameters in albino Wistar rats exposed to lead nitrate.&#x0D; Methods: Thirty male albino Wistar rats weighing between 174- 196g were assigned to six groups of five animals. Group 1 served as control, group 2 received 50mg/kg body weight lead nitrate (PbNO3), groups 3 and 4 received 500 mg/kg body weight aqueous extract of Carica papaya leaves (CPL) and Carica papaya seed (CPS) respectively, groups 5 and 6 received 50mg/kg body weight PbNO3 + 500mg/kg body weight CPL and CPS respectively for 31 days by oral gavaging. Animals were sacrificed and blood collected for various assay using standard methods. ANOVA on SPSS version 25 was used to determine variations within and between groups.&#x0D; Results: Increases in sodium and potassium, and decreases in chloride, calcium and bicarbonate levels were observed in the lead intoxicated group. Treatment with CPL and CPS reversed the alterations in electrolytes. Levels of RBC, PCV, Hb, MCH, MCHC and lymphocytes were lower in the lead intoxicated group relative to the lead intoxicated groups complemented with CPL and CPS, while WBC, MCV and platelet counts were higher in the lead intoxicated group when compared to the group complemented with CPL and CPS.&#x0D; Conclusion: This finding suggests that CPL and CPS could be protective against lead induced alterations in electrolytes and hematological parameters and could be harnessed for these potentials.

Metabolic Acidosis Results in Sexually Dimorphic Response in the Heart Tissue.

Metabolic acidosis (MA) is a highly prevalent disorder in a significant proportion of the population, resulting from imbalance in blood pH homeostasis. The heart, being an organ with very low regenerative capacity and high metabolic activity, is vulnerable to chronic, although low-grade, MA. To systematically characterize the effect of low-grade MA on the heart, we treated male and female mice with NH4Cl supplementation for 2 weeks and analyzed their blood chemistry and transcriptomic signature of the heart tissue. The reduction of pH and plasma bicarbonate levels without an associated change in anion gap indicated a physiological manifestation of low-grade MA with minimal respiratory compensation. On transcriptomic analysis, we observed changes in cardiac-specific genes with significant gender-based differences due to MA. We found many genes contributing to dilated cardiomyopathy to be altered in males, more than in females, while cardiac contractility and Na/K/ATPase-Src signaling were affected in the opposite way. Our model presents a systems-level understanding of how the cardiovascular tissue is affected by MA. As low-grade MA is a common ailment with many dietary and pharmaceutical interventions, our work presents avenues to limit chronic cardiac damage and disease manifestation, as well as highlighting the sex differences in MA-induced cardiovascular damage.

Association Between Serum Bicarbonate Levels and Prediabetes and Subclinical Inflammation in Young Healthy Adults: A Cross-sectional Study.

Low bicarbonate, a hallmark of metabolic acidosis is associated with various diseases. This study investigated associations between bicarbonate levels with prediabetes and subclinical inflammation among healthy young adults in Qatar. A cross-sectional study was carried out with 825 participants aged 18-40 years, devoid of any known comorbidities, using data from the Qatar Biobank. For each participant, blood samples were taken for measurements of bicarbonate, prediabetes, and subclinical inflammation biomarkers. Prediabetes was defined using HbA1c between 5.7 and 6.4% and subclinical inflammation was defined using monocyte to high density lipoprotein (HDL) cholesterol ratio (MHR). Associations between bicarbonate levels and the outcomes were analyzed using multivariable linear and logistic regression and then stratified by gender. A total of 825 participants with mean age 29.2 years (5.9) of which 365 (44.2%) were males. After multivariable logistic regression, each unit increase in serum bicarbonate was associated with a 17% decreased risk of prediabetes (OR: 0.83, 95%CI: 0.70-0.99, p=0.034), in males but no association was observed for females. Similarly, after multivariable linear regression, a unit increase in serum bicarbonate was associated with a 0.18 unit decrease in MHR (beta -0.18, 95%CI: -0.29, -0.07, p=0.002), again with no association observed in females. In a healthy young adult population, higher serum bicarbonate levels were inversely associated with both prediabetes and subclinical inflammation in males, but not in females.

A Clinical and Biochemical Comparative Study Of Diabetic Ketoacidosis (DKA) in Newly Diagnosed Vs Known Cases of Type 1 Diabetic Children

Objectives: We aimed to study the characterizing clinical and biochemical profiles of Diabetic Ketoacidosis (DKA) in children with newly diagnosed Type 1 Diabetes Mellitus (Type 1DM) compared to children with established diagnosis of Type 1DM presenting with DKA admitted to the pediatric intensive care unit of a large university hospital in the eastern region of Saudi Arabia. Methods: We retrospectively reviewed the medical records of 211 patients who were admitted to the pediatric intensive care unit with diabetic ketoacidosis between 2010 and 2019. The diagnosis of diabetic ketoacidosis was based on symptoms of polydipsia, polyurea, weight loss, vomiting, dehydration, abdominal pain, breathing problems, lethargy or coma, biochemical hyperglycemia (blood glucose level of >200 mg/dL), venous pH of <7.3, serum bicarbonate level of ≤15 mEq/L, and ketonemia (blood β -hydroxybutyrate concentration of ≥3 mM) or moderate or severe ketonuria (diagnosed as newly acquired type 1 diabetes). Results: The rate of newly diagnosed Type 1 DM with DKA was 41.7%, out of them who got severe and moderate diabetic ketoacidosis were 61.6% and 38.4%, respectively. We observed significantly increased heart and respiratory rates in patients newly diagnosed with diabetic ketoacidosis and in those with severe diabetic ketoacidosis (p<0.001) compared to known cases with Type 1DM presenting with DKA. We also identified significantly increased biochemical indices including HbA1c, random blood sugar, serum osmolality, blood urea nitrogen, creatinine, chloride, lactate, and anion gap in relation to severe diabetic ketoacidosis and newly diagnosed type 1 diabetes (p ≤ 0.05). Conclusions: We found that the clinical and biochemical profiles of patients with newly diagnosed Type 1 DM children were significantly affected compared to children who were known Type 1DM presenting with DKA.

CYP24A1 and CYP3A4 Levels, Renal, Hepatic Changes, and Incidence of Oxidative Stress in Tramadol-Alcohol Concomitant Misuse.

Introduction Long-term population-based research has demonstrated a link between heavy drinking and the prevalence of kidney disorders; similarly, alcohol abuse has long been recognized as one of the main causes of liver diseases. A recent trend of concomitant use of the opioid analgesic Tramadol and alcohol amongyoung males in sub-Saharan Africa has emerged. Aim and objectives This study's primary aim was to evaluate the incidence of concomitant use of alcohol and Tramadolamong adult males, and observe the role ofcytochrome p450 3A4 and CYP24A1 proteins and some oxidative stress indicators such as Malondialdehyde, lactate dehydrogenase, among study participants. The secondary aim was to evaluate the effect of alcohol and Tramadol concomitant use on Liver and kidney indices. Methods Our study population was male subjects with a history of Alcohol and Tramadol concomitant use. Liver enzymes, renal indices, oxidative stress markers, and CYP3A4 and CYP24A1were determined from the serum of test and control participants. IBM Statistical Package for Social Sciences (SPSS) Statistics (version 21.0) was used to analyze the data obtained. Result One hundred and forty-two male subjects were included in this study. Eighty two (82) were males who admitted to abuse of Alcohol and Tramadol concomitantly for at least a year. The dose of Tramadol commonly used by Test subjects was 200 mg (43.9% of the test population), Tramadol users in the study population were largely Undergraduates (75.6% of Test participants). Gamma-glutamyl transferase and lactate dehydrogenase were significantly higher in Test subjects consuming Tramadol and alcohol combination (43.13±1.02 and 117.29±2.45, respectively) versus control (24.87±0.82; p=0.00 and 101.93±1.25; p=0.00). There was a significant decrease in serum bicarbonate levels of Test subjects (16.19±0.53) versus control (22.60±0.68; p=0.000). Cytochrome P450 24A1, was significantly lower in Test subjects (subjects consuming Tramadol and alcohol combination) (0.90±0.06; p=0.01), and significantly threefold higher in subjects with acute myeloid leukemia (AML) (5.16±0.5; p=0.00), when compared with values of non-drug/alcohol users that served as normal control (1.27±0.07). Conclusion The menace of Tramadol and alcohol concomitant abuse has taken a worrisome dimension in sub-Saharan Africa. In this study 77.4% of participants reported euphoria as reason for combining Alcohol and Tramadol, 6.5% claimed it was for faster pain relief and enhanced sexual performance or prolong penile erection was the response of 58.1% of the test participants. Findings of reduced CYP3A4 with Alcohol and Tramadol concomitant use could be associated with delayed drug inactivation and increased drug euphoric action.

Longitudinal analysis of electrolyte prolife in intensive care COVID-19 patients

ABSTRACT Introduction According to a substantial body of research, electrolyte abnormalities are a common manifestation in coronavirus disease 2019 (COVID-19) patients and are associated with adverse outcomes. This study aimed to investigate electrolyte imbalances in COVID-19 patients and assess their relation to mortality. Methods Adult COVID-19 patients hospitalized in the Security Forces Hospital in Saudi Arabia from June 8th till August 18th, 2020 were enrolled in this retrospective observational study. We examined baseline characteristics, comorbidities, acute organ injuries, medications, and electrolyte levels including sodium, potassium, chloride, calcium, bicarbonate, phosphate, and magnesium on ICU admission, as well as every following day of ICU stay, until death or discharge. Patients were stratified according to survival, and differences in variables between groups were compared using Mann-Whitney’s U test or Fisher’s exact test. Longitudinal electrolyte profiles were modeled using random intercept linear regression models. Results A total of 60 COVID-19 patients were enrolled. Compared to survivors, non-survivors had significantly higher sodium and phosphate on admission and death, higher potassium and magnesium at death, and significantly lower calcium at death. Abnormalities in admission levels of chloride and bicarbonate were also more frequently observed in non-survivors. Furthermore, in the deceased group, we observed a daily increase in potassium and phosphate levels, and a daily decrease in sodium and chloride. Finally, calcium increased in non-survivors over time, however, not as significantly as in the survivor group. Conclusion Admission levels of electrolytes and changes over the course of ICU stay appear to be associated with mortality in COVID-19 patients.

Effect of Sodium Bicarbonate Ringer's Solution on Intraoperative Blood Gas Analysis and Postoperative Recovery Time in Liver Transplantation: A Single-Center Retrospective Study.

BACKGROUND Sodium bicarbonate Ringer's solution (BRS) is the latest generation of balanced crystal solutions. BRS does not increase the liver burden, but its impact in liver transplantation is unclear. The aim of this study was to investigate the effect of BRS as a fluid therapy on intraoperative blood gas analysis and postoperative recovery time in orthotopic liver transplantation (LT) patients. MATERIAL AND METHODS The study included 101 patients who received classical in situ liver transplantation at the Second Affiliated Hospital of Guangxi Medical University from November 2019 to January 2022. The patients were divided into 2 groups according to the intraoperative fluid infusion: the BRS group and the sodium lactate Ringer's solution group (LRS group). Intraoperative blood gas analysis, including pH, base excess (BE), bicarbonate, and lactic acid levels of radial artery blood, were collected after induction (T0), 30 min before opening (T1), 30 min after no liver period (T2), 30 min after opening (T3), and at the end of the operation (T4). Postoperative ICU catheter time, ICU stay time, and total hospitalization days were also recorded and compared between the 2 groups. RESULTS Lactic acid levels were decreased significantly at T3 in the BRS group (P<0.05). ICU catheter time, ICU hospitalization days, and total hospitalization days were significantly shorter in the BRS group (P<0.05). CONCLUSIONS BRS can decrease the lactic acid level at 30 min after opening, reducing the postoperative recovery time. BRS is more effective than LRS in liver transplantation.

Prevalencia de acidosis metabólica en derivaciones ileales tras más de un año de la cistectomía radical y repercusiones metabólicas secundarias asociadas

Introduction and objectiveMetabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. Materials and methodsWe conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level <22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24±42.36 months. ResultsMA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19.65%, P<.001) and renal failure (100% vs 45.29%, P<.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all P<.05).Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR: 0.914; 95% CI: 0.878-0.95; P<.0001), proving a close correlation with venous bicarbonate values (r=.387, P<.001). ConclusionsMA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.

Burden and severity of deranged electrolytes and kidney function in children seen in a tertiary hospital in Kano, northern Nigeria.

Derangement in serum electrolytes and kidney function is often overlooked, especially in resource-constrained settings, and associated with increased risk of morbidity and mortality. This study aimed to describe the burden of derangements in serum electrolytes and kidney function in children presenting to a tertiary hospital in Nigeria. The laboratory records of all children who had serum electrolytes urea and creatinine ordered on their first presentation to hospital between January 1 and June 30, 2017 were retrospectively reviewed. Basic demographic data including admission status (inpatient or outpatient) were recordedandserum levels of sodium, potassium, chloride and bicarbonate were assessed for derangements usingnormal values from established reference ranges. Results of repeat samples were excluded. Kidney function was classified based on the serum creatinine relative to normal values for age and sex. During the study period, 1909 children (60.3% male); median (IQR) age 42 (11.9) months had serum chemistry and 1248 (65.4%) were admitted. Results of their first samples were analyzed. Electrolyte derangements were present in 78.6% of the samples most commonly hyponatraemia (41.1%), low bicarbonate(37.2%), hypochloraemia (33.5%) and hypokalemia(18.9%). Azotaemia was found in 20.1% of the results. Elevated serum creatinine levels were found in 399 children (24.7%), 24.1% of those being in the severe category. Children aged 5 years and younger accounted for 76.4% of those with derangement in kidney function. One hundred and eight outpatients (17.8%) had deranged kidney function. Deranged serum electrolytes and kidney function were common in this cohort.

A retrospective study on comparison of clinical characteristics and outcomes of diabetic ketoacidosis patients with and without acute pancreatitis

The co-existence of diabetic ketoacidosis (DKA) with acute pancreatitis (AP) is associated with unfavorable clinical outcomes. However, diagnosing AP in DKA patients is challenging and often missed due to overlapping symptoms. The aim of this retrospective observational study was to compare the clinical characteristics and outcomes of patients with concomitant DKA and AP or DKA alone. Data of patients with DKA admitted between January 2015 to August 2021 to four hospitals in Qatar was extracted from the electronic health record (Cerner). American Diabetes Association criteria and Atlanta criteria were used for DKA and AP diagnosis, respectively. Independent T-test or Mann–Whitney U test was used to analyze continuous variables, whereas categorical variables were analyzed via Chi-square or Fischer exact tests as appropriate. Univariate and multivariate logistic regression models were generated to assess the correlations. A p-value of < 0.05 was considered statistically significant. Of 936 patients with DKA, 84 (9.0%) had coexisting AP. AP was most common in the Asian race (66%, p < 0.001). Patients with DKA and AP were older, had higher admission anion-gap, white cell count, hemoglobin (hb), neutrophil/lymphocyte ratio, urea, creatinine, maximum blood glucose during the episode, total cholesterol and triglyceride level (TGL) (p < 0.05). They had a lower admission venous pH and bicarbonate at 6 h. Patients in the DKA with AP group also had a longer length of stay (LOS), DKA duration and a higher rate of ICU admission (p-values ≤ 0.001). In-hospital mortality, 3-month all-cause readmission, 6-month and 12-month DKA recurrence did not differ between the two groups. Univariate logistic regression analysis showed age, Asian ethnicity, male gender, T2D, admission WBC count, hb, urea, creatinine, potassium, venous pH, bicarbonate, anion gap, total cholesterol, TGL and LDL level were significantly associated with the development of DKA with AP (p < 0.05). In multivariate logistic regression analysis, age and total cholesterol level were associated with concomitant DKA and AP (p < 0.05). Patients with concomitant DKA and AP have more severe derangement in markers of DKA severity, inflammation, kidney injury and metabolic profile, along with a longer DKA duration, LOS and requirement for ICU support compared to DKA patients without AP. This highlights the clinical significance of diagnosing the co-existence of DKA with AP, as the combination results in significantly worse clinical outcomes and greater healthcare utilization than in patients with only DKA.

Low carbohydrate intake correlates with trends of insulin resistance and metabolic acidosis in healthy lean individuals.

Both obesity and a poor diet are considered major risk factors for triggering insulin resistance syndrome (IRS) and the development of type 2 diabetes mellitus (T2DM). Owing to the impact of low-carbohydrate diets, such as the keto diet and the Atkins diet, on weight loss in individuals with obesity, these diets have become an effective strategy for a healthy lifestyle. However, the impact of the ketogenic diet on IRS in healthy individuals of a normal weight has been less well researched. This study presents a cross-sectional observational study that aimed to investigate the effect of low carbohydrate intake in healthy individuals of a normal weight with regard to glucose homeostasis, inflammatory, and metabolic parameters. The study included 120 participants who were healthy, had a normal weight (BMI 25 kg/m2), and had no history of a major medical condition. Self-reported dietary intake and objective physical activity measured by accelerometry were tracked for 7 days. The participants were divided into three groups according to their dietary intake of carbohydrates: the low-carbohydrate (LC) group (those consuming <45% of their daily energy intake from carbohydrates), the recommended range of carbohydrate (RC) group (those consuming 45-65% of their daily energy intake from carbohydrates), and the high-carbohydrate (HC) group (those consuming more than 65% of their daily energy intake from carbohydrates). Blood samples were collected for the analysis of metabolic markers. HOMA of insulin resistance (HOMA-IR) and HOMA of β-cell function (HOMA-β), as well as C-peptide levels, were used for the evaluation of glucose homeostasis. Low carbohydrate intake (<45% of total energy) was found to significantly correlate with dysregulated glucose homeostasis as measured by elevations in HOMA-IR, HOMA-β% assessment, and C-peptide levels. Low carbohydrate intake was also found to be coupled with lower serum bicarbonate and serum albumin levels, with an increased anion gap indicating metabolic acidosis. The elevation in C-peptide under low carbohydrate intake was found to be positively correlated with the secretion of IRS-related inflammatory markers, including FGF2, IP-10, IL-6, IL-17A, and MDC, but negatively correlated with IL-3. Overall, the findings of the study showed that, for the first time, low-carbohydrate intake in healthy individuals of a normal weight might lead to dysfunctional glucose homeostasis, increased metabolic acidosis, and the possibility of triggering inflammation by C-peptide elevation in plasma.

Metabolic Acidosis and Adverse Outcomes and Costs in CKD: An Observational Cohort Study

Metabolic acidosis is a risk factor for progression of chronic kidney disease (CKD), but little is known about its effect on health care costs and resource utilization. We describe the associations between metabolic acidosis, adverse kidney outcomes, and health care costs inpatients with CKD stages G3-G5 and not receiving dialysis. Retrospective cohort study. An integrated claims-clinical data set of US patients with CKD stages G3-G5, with serum bicarbonate values of 12 to<22 mEq/L (metabolic acidosis group) or 22 to 29 mEq/L (normal serum bicarbonate level group). The primary exposure variable was the baseline serum bicarbonate level. The primary clinical outcome was the composite of all-cause mortality, maintenance dialysis, kidney transplant, or a decline in the estimated glomerular filtration rate of≥40% (DD40). The primary cost outcome was all-cause predicted per-patient per-year cost, assessed over a 2-year outcome period. Logistic and generalized linear regression models, adjusted for key covariates such as age, sex, race, kidney function, comorbidities, and pharmacy insurance coverage, were used to assess serum bicarbonate levels as a predictor of DD40 and health care costs, respectively. 51,558 patients qualified. The metabolic acidosis group experienced higher rates of DD40 (48.3% vs. 16.7%, P<0.001) and higher all-cause yearly costs ($65,172 vs. $24,681, P<0.001). Two-year adjusted odds ratio of DD40 per 1-mEq/L increase in serum bicarbonate levels was 0.873 (95% CI, 0.866-0.879); the parameter estimate (±SE) for costs was-0.070±0.0075 (P<0.001). Possible residual confounding. Patients with CKD and metabolic acidosis had higher costs and rates of adverse kidney outcomes compared with patients with normal serum bicarbonate levels. Each 1-mEq/L increase in serum bicarbonate levels was associated with a 13% decrease in 2-year DD40 events and a 7% decrease in per-patient per-year cost.